eMedicine Specialties > Plastic Surgery > Lower Extremity Reconstruction

Lower Extremity Reconstruction, Foot: Workup

Author: Fabio Santanelli, MD, PhD, Associate Professor of Plastic Surgery, University of Rome; Chief of Unita Operativa Dipartimentale di Chirurgia Plastica, Azienda Ospedaliera, Sant'Andrea, Rome
Coauthor(s): Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy; Stefania Tenna, MD, Consulting Staff, Department of Plastic Surgery, University of Rome Policlinico Umberto I, Italy; Guido Paolini, MD, Plastic Surgery Unit, Assistant Professor of Plastic Surgery, Sant'Andrea Hospital- University of Rome La Sapienza -Italy; Emanuele Cigna, MD, Consultant Plastic Surgeon, Department of Plastic and Reconstructive Surgery, University of Rome La Sapienza, Italy
Contributor Information and Disclosures

Updated: Jun 26, 2008

Workup

Laboratory Studies

  • Obtain a complete blood count (CBC).
  • Obtain prothrombin time and activated partial thromboplastin time to check for coagulopathy.
  • Check for blood sugar if suggested by anamnesis.

Imaging Studies

  • Obtain leg and/or foot radiographs for patients with trauma or for osteocutaneous free transfers (see Image 5).
  • Obtain a chest radiograph if indicated by examination findings or the patient's history.
  • Obtain leucocyte lymphoscintigraphy in patients with osteomyelitis.
  • Obtain baropodometric evaluation or gait analysis to identify eventual bone functional loss and to plan a repair of the arches (see Image 6).
  • Nuclear magnetic resonance especially is indicated to study ligaments and joints but also to evaluate the soft tissue damage (see Image 7).

Other Tests

  • Perform Doppler, echo Doppler, or angiography to assess the vascular pattern of the foot and leg.
  • Perform an Allen test in patients with radial free flaps.
  • Obtain an ECG in elderly individuals or as per operating room guidelines.

More on Lower Extremity Reconstruction, Foot

Overview: Lower Extremity Reconstruction, Foot
Workup: Lower Extremity Reconstruction, Foot
Treatment: Lower Extremity Reconstruction, Foot
Follow-up: Lower Extremity Reconstruction, Foot
Multimedia: Lower Extremity Reconstruction, Foot
References
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References

  1. McCraw JB. Selection of alternative local flaps in the leg and foot. Clin Plast Surg. Apr 1979;6(2):227-46. [Medline].

  2. Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg. Sep 1979;64(3):295-8. [Medline].

  3. Grabb WC, Argenta LC. The lateral calcaneal artery skin flap (the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap). Plast Reconstr Surg. Nov 1981;68(5):723-30. [Medline].

  4. McCraw JB, Furlow LT Jr. The dorsalis pedis arterialized flap. A clinical study. Plast Reconstr Surg. Feb 1975;55(2):177-85. [Medline].

  5. Masquelet AC, Romana MC. The medialis pedis flap: a new fasciocutaneous flap. Plast Reconstr Surg. May 1990;85(5):765-72. [Medline].

  6. Baudet J, Guimberteau JC, Nascimento E. Successful clinical transfer of two free thoraco-dorsal axillary flaps. Plast Reconstr Surg. Dec 1976;58(6):680-8. [Medline].

  7. Robinson DW. Microsurgical transfer of the dorsalis pedis neurovascular island flap. Br J Plast Surg. Jul 1976;29(3):209-13. [Medline].

  8. Dos Santos F. L'artere scapulaire posterieure. Paris; 1980.

  9. Acland RD, Schusterman M, Godina M, et al. The saphenous neurovascular free flap. Plast Reconstr Surg. Jun 1981;67(6):763-74. [Medline].

  10. Song R, Song Y, Yu Y. The upper arm free flap. Symposium on one stage reconstruction. In: Song R, ed. Clinics in Plastic Surgery. Vol 9. New York: WB Saunders; 1982:27-36.

  11. Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. May 1975;55(5):533-44. [Medline].

  12. Taylor GI. The current status of free vascularized bone grafts. Clin Plast Surg. Jan 1983;10(1):185-209. [Medline].

  13. Hidalgo DA, Shaw WW. Reconstruction of foot injuries. Clin Plast Surg. Oct 1986;13(4):663-80. [Medline].

  14. Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region: a preliminary report. Scand J Plast Surg. 1983;17:191.

  15. Pakiam AI. The reversed dermis flap. Br J Plast Surg. Apr 1978;31(2):131-5. [Medline].

  16. Nassif TM, Vidal L, Bovet JL, et al. The parascapular flap: a new cutaneous microsurgical free flap. Plast Reconstr Surg. Apr 1982;69(4):591-600. [Medline].

  17. Chang Di Sheng. Radial artery fascial flap. Presented at: Annual Meeting of the American Society of Plastic Reconstructive Surgery. Honolulu, HI; October 1982.

  18. Masuoka T, Nomura S, Yoshimura K, et al. Deep inferior epigastric perforator flap for foot reconstruction using an external pedicle. J Reconstr Microsurg. May 2005;21(4):231-4. [Medline].

  19. Mathes SJ, Nahai F. Clinical application for muscle and musculocutaneous flaps. St Louis: Mosby; 1982.

  20. Morrison WA, Crabb DM, O'Brien BM, et al. The instep of the foot as a fasciocutaneous island and as a free flap for heel defects. Plast Reconstr Surg. Jul 1983;72(1):56-65. [Medline].

  21. Nerlich AG, Zink A, Szeimies U, et al. Ancient Egyptian prosthesis of the big toe. Lancet. Dec 23-30 2000;356(9248):2176-9. [Medline].

  22. O'Brien B McC, Morrison WA. Reconstructive Microsurgery. Churchill Livingstone; 1987.

  23. O'Brien BM, MacLeod AM, Hayhurst JW, et al. Successful transfer of a large island flap from the groin to the foot by microvascular anastomoses. Plast Reconstr Surg. Sep 1973;52(3):271-8. [Medline].

  24. Organek AJ, Klebuc MJ, Zuker RM. Indications and outcomes of free tissue transfer to the lower extremity in children: review. J Reconstr Microsurg. Apr 2006;22(3):173-81. [Medline].

  25. Strauch B, Vasconez LO, Hall-Finlay EJ. Grabb's Encyclopedia of Flaps. Vol 3. 2nd ed. Philadelphia: Lippincott-Raven; 1998.

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Further Reading

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Keywords

lower extremity reconstruction, foot surgery, foot pressure, foot reconstruction, foot surgery, weightbearing, foot defects, foot ulcers, padding properties, body weight, foot flap, saphenous nerve, sciatic nerve, ankle, sole, dorsum, toes, extensor brevis digitorum, extensor hallucis, metatarsal bones, anterior tibial pedicle, posterior tibial pedicle, peroneal pedicle, internal plantar nerve, posterior tibial nerve

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Contributor Information and Disclosures

Author

Fabio Santanelli, MD, PhD, Associate Professor of Plastic Surgery, University of Rome; Chief of Unita Operativa Dipartimentale di Chirurgia Plastica, Azienda Ospedaliera, Sant'Andrea, Rome
Fabio Santanelli, MD, PhD is a member of the following medical societies: American Society of Plastic and Reconstructive Surgery, European Association of Plastic Surgeons, and International Confederation for Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Francesca Romana Grippaudo, MD, Assistant Professor, Unit of Plastic Surgery, 2nd Medical Faculty, Sapienza University of Rome, Italy
Francesca Romana Grippaudo, MD is a member of the following medical societies: International Confederation for Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

Stefania Tenna, MD, Consulting Staff, Department of Plastic Surgery, University of Rome Policlinico Umberto I, Italy
Disclosure: Nothing to disclose.

Guido Paolini, MD, Plastic Surgery Unit, Assistant Professor of Plastic Surgery, Sant'Andrea Hospital- University of Rome La Sapienza -Italy
Disclosure: Nothing to disclose.

Emanuele Cigna, MD, Consultant Plastic Surgeon, Department of Plastic and Reconstructive Surgery, University of Rome La Sapienza, Italy
Disclosure: Nothing to disclose.

Medical Editor

Christian Paletta, MD, FACS, Professor, Division Chief and Program Director, Department of Plastic and Reconstructive Surgery, St Louis University School of Medicine
Christian Paletta, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

B Sekhar Chandrasekhar, MD, Associate Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Southern California
B Sekhar Chandrasekhar, MD is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Society for Reconstructive Microsurgery, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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